Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 204990 | NY |
NPI | 1508962002 |
---|---|
Provider Name | Dr. Tracy Onal |
First Address | East Islip, NY 11730-2502 |
Second Address | East Islip, NY 11730-2502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 11/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G60752 | (02) | NY |